IOCconsensuson“Painmedica1on”insport2.4.November2016

Incidence and prevalence of analgesic use in elite sport: Overview of

literature review and methodology

IOC Consensus Meeting on Pain Management in Elite Athletes, November 2016

Wayne Derman, MBChB, PhD Chris Harle, PhD

John Orchard, MD, PhD

n=3,852Screening

Included

Eligibility

Identification

Recordsafterduplicatesremoved(n=3,668)

Recordsscreened(n=3,668)

Recordsexcluded(n=3,581)

Full-textarticlesassessedforeligibility

(n=87)

Full-textarticlesexcluded(n=28)

n=64

Recordsidentifiedthroughothersources(n=5)

0

10

20

30

40

50

60

70

Supplements orMedication

Medication NSAIDS

WC 2002WC 2006WWC 2003WWC 2007U-20 2005U-20 2007U-17 2005U-17 2007

Theuseandabuseofpainkillersininterna1onalfootball:Datafrom6FIFAtournamentsforfemaleandyouthplayers-Aprospec1vesurveyP.Tscholl,N.Feddermann,A.Junge,J.Dvorak,AJSM2008

5 3

Medica1onsduringFIFACompe11ons,5’432players

Why do athletes take drugs?

legitimate therapeutic use performance continuation – fighting symptoms recreational / social use performance enhancement. à predominantly healthy Mottram DR (2005)

Kennedy MC (1999) MJA

Medication

Non-steroidal anti-inflammatory

Other analgesics

B2-Agonists

Injections corticosteroids

Psychotropic substances

NSAIDs in International Football – during one season

92%ofadultplayers75%ofyouthplayersuseNSAIDsperseason15%ofyouthplayersaredailyusersà prophylactic and systematical use?

Taioli E (2007) BJSM, Warner DC (2002) J Adolesc Health.

Narcotics

5-15% of the players take narcotics at night Highly depended on physician / team

Grobler LA (2000) CJSM

In- out competition

Team or single event success

Playing or being reserve in the match

Tscholl et al 2008 BJSM, Tscholl et al 2009 AJSM

No influence

Factors associated with increased use of medication

Team physician Geographic origin Age

Physical demand Female athlete

2002 FIFA World CupTM

22 out of 23 qualified players were using at least one painkilling agent prior to a match during the entire

tournament!

Factors associated with increased use of medication

Team physician Geographic origin Age

Physical demand Female athlete

Factors associated with increased use of medication

Team physician Geographic origin Age

Physical demand Female athlete

n.s.

*

* * *

* p<0.01

Factors associated with increased use of medication

Team physician Geographic origin Age

Physical demand Female athlete

More medication More painkillers

More b2-agonists More narcotics but less

myorelaxants

OveruseSyndromesareCommone.g.ShoulderImpingementSyndrome

Males(n=174)

Females(n=210)

Total(n=384)

Acetaminophen 10 19 29

NSAIDs60(33%) 80(38%) 140

AnaestheLc 0 10 10

Opioidreceptorantagonist 0 2 2

Dataderivedfrom384(M:174;F:210)declaraLonformssubmiQedatthe2013WorldSwimmingChampionshipsheldinBarcelona,Spain.

AnalgesicUseamongSwimmers

CauseofMostGamesMissed

PatellofemoralInflamma6on17.5%LateralAnkleSprains 8.8%KneeSprains7.4%LumbarStrains6.6%

#1

#2

#3

#4

DrakosMCetal.SportsHealth2010;2:284-290

ItcanbeassumedthatthereissignificantuseoffNSAIDstoaddresstheveryfrequentincidenceof

patellofemoralinflamma6onamongbasketballers.

NSAIDUseintheXVPanAmGames

.DaSilvaERetal.BrJSportsMed2011;45:91-94

MarijuanaUse(withinthelast12monthsNCAA)

24%!

25%!25%!

18%!18%!

17%!

10%!

15%!

20%!

25%!

30%!

35%!

2005! 2009! 2013!

Male!Female!

Author’s pain-related takeaways Tscholl, Junge, Vaso, Weber, Dvorak

“Professional football players—mostly healthy athletes—consume a considerable quantity of medication, especially non-steroidal anti-inflammatory drugs, prior to competition. These results are alarming.” 2008 (World Cup 2002/2006)

“Overuse of medication in man, women, U-17 and U-20 cause for alarm (2009, FWC, WWC, U-17, U-20 FWC)

“Lesson not learned” (FWC 2010)

“Is it part of the game for players and physicians?” FWC 2014

Compared to Rio 2016 data •  Survey of 107 Olympic team physicians (Stuart et al.) •  Prescribing behavior in last 12 months:

•  Oral NSAIDs - over 80% of physicians

•  Paracetamol/acetaminophen and topical NSAIDs – over 50% of physicians

•  24% of physicians report routine use in over 30% of athletes •  As pain becomes severe …

•  oral NSAIDs, paracetamol, and topical NSAIDs !

•  oral opioids & injectables (NSAIDs, anesthetics, corticosteroids, opioids) "